How family functioning shapes prenatal bonding: a mediation analysis of depressive symptoms and maternal–fetal attachment

Objective: Pregnancy is a period in a woman's life characterized by profound hormonal, psychological, and social changes, which may lead to increased emotional vulnerability, during which depressive symptoms may negatively affect maternal well-being and maternal-fetal attachment. Although family functioning has traditionally been examined mainly in relation to psychopathology, its protective role during pregnancy remains insufficiently explored. This study examined whether depressive symptoms mediate the association between family functioning and antenatal maternal attachment. Methods: The sample consisted of 261 pregnant women enrolled in a multicenter Italian perinatal mental health project. The present add-on study focused specifically on family functioning, social support, and maternal antenatal attachment. Participants completed self-report measures assessing depressive symptoms (Edinburgh Postnatal Depression Scale), maternal-fetal attachment (Maternal Antenatal Attachment Scale), family functioning (Family Functioning Questionnaire), perceived partner support, and social network quality. Structural equation modeling was used to test a mediation model in which depressive symptoms mediated the relationship between family functioning and two attachment dimensions: quality of attachment and intensity of preoccupation. Models were estimated using full-information maximum likelihood with bootstrapped confidence intervals. Results: Higher family functioning was significantly associated with lower depressive symptom severity. Depressive symptoms were negatively associated with attachment quality but not with intensity of preoccupation. A small but significant indirect effect of family functioning on attachment quality, mediated by depressive symptoms, emerged, indicating partial mediation. No mediation effect was observed for intensity of preoccupation, which showed a direct positive association with family functioning. These results remained substantially unchanged after controlling for perceived partner support and social network quality. Conclusion: Depressive symptoms partially mediate the relationship between family functioning and the emotional quality of maternal-fetal attachment, whereas the intensity of preoccupation appears to be more directly linked to the broader family environment. These findings underscore the importance of assessing family functioning during pregnancy and suggest that interventions targeting both family dynamics and maternal depressive symptoms may foster healthier prenatal attachment.